Diskectomy can relieve back pain

Q: I have a herniated disk that’s been bothering me for more than a year. I’ve tried exercise, medication and complementary therapies. Nothing has helped. What are my surgical options?

A: Let’s start with a brief anatomy lesson. The human spine consists of a column of interlocking bones called vertebrae. They surround and protect the spinal cord. Vertebrae are stacked on top of each other. In between each pair of vertebrae is a little shock-absorbing cushion called an intervertebral disk.

Intervertebral disks — think of miniature jelly doughnuts — prevent the vertebrae from scraping against each other. A normal disk has a jelly-like center (the nucleus) and a tough outer covering.

As we age, the disk’s nucleus begins to dehydrate, harden and lose its jellylike property. The outer shell starts to tear, thin and weaken. As the disk deteriorates, it loses its ability to absorb shocks, making the affected vertebrae more susceptible to injury.

A herniated disk — also called a “slipped” or “ruptured” disk — occurs when the inner core of the disk bulges through the outer shell. The protruding disk may press on a nearby nerve root, the beginning of a nerve.

There are 31 pairs of nerves that come out of the spinal cord, one of each pair going to the right and left sides of the body. Each nerve carries fibers that send signals from the brain to muscles. That’s how we move. If we want to walk, the brain sends signals down to the nerves connecting to the muscles of the legs.

Each nerve also carries fibers that send signals from the body to the brain — signals indicating sensations such as heat, touch or pain. Pressure on the nerve roots can cause inflammation and resulting pain in the back and leg.

An MRI gives a much better picture of the vertebrae and the disks than X-rays. When I was a medical student, X-rays were all we had. That made it much harder to know if a person’s back pain was due to a herniated disk.

Most people with herniated disks recover within several months without surgery. Since that hasn’t been true for you, disk surgery may be needed.

A common type of disk surgery is diskectomy. During the procedure, the surgeon makes an opening in the spinal canal, through which the spinal cord passes. The surgeon removes any disk material that has fragmented and escaped into the spinal canal. If part of the herniated disk is protruding into the spinal canal, compressing a nerve root, the surgeon will trim the bulging portion.

There are many variations on this standard diskectomy, but all of the procedures are designed to relieve pressure on the spinal nerve roots. Your surgeon can help determine what’s best for you.

DR. ANTHONY KOMAROFF is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.askdoctork.com.

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